Intrapartum ultrasonographic estimates of fetal weight by the house staff

Article Abstract:

Ultrasonography is a valuable tool for estimating fetal weight, which can indicate the potential for complications. Many of the formulas for estimating fetal weight depend on measurements made by trained ultrasonographers in laboratory settings, conditions that often cannot be duplicated in busy obstetrical departments. This prospective study was carried out to evaluate the accuracy of ultrasonographic estimates of fetal weight by resident physicians in an inner-city hospital labor department. The admitting third- or fourth-year resident performed an ultrasound evaluation for 109 patients (115 sets of measurements) and the difference between the estimated and actual birth weights was noted. These estimates were made when it was believed that such an approach would help in managing labor. Two hundred five estimates of birth weight were generated (based on measuring different fetal dimensions), of which, 60 percent were within 10 percent of the actual birth weights. This level of accuracy was similar cases in which birth weights were calculated using the biparietal diameter/abdominal circumference ratio or using the femur length/abdominal circumference ratio. The average error in estimated fetal weight was approximately 9 percent, and was not significantly different for very-low-birth-weight babies. The results show that the house staff in a busy setting is capable of estimating fetal weight as accurately as trained ultrasonographers in more controlled settings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Residents (Medicine), Birth weight, Prenatal diagnosis, Prenatal ultrasonography, Ultrasonics in obstetrics

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Antepartum fetal surveillance tests during sickle cell crisis

Article Abstract:

Pregnant women with sickle cell disease (a genetic abnormality of hemoglobin, which results in abnormal 'sickle-shaped' red blood cells) may develop sickle cell crisis, a condition of sudden intense pain in the abdomen, chest, or other regions necessitating hospitalization. This study presents results from standard prenatal tests performed on 24 women during 39 crisis episodes. During the crisis period, the proportion of scores on nonreactive nonstress tests (NSTs) was higher than during non-crisis periods. More fetal biophysical profile scores, a composite measure including results from NSTs, fetal movement measurements, fetal tone, and amniotic fluid volume, were lower during crisis periods than noncrisis periods. Parameters most often associated with sickle cell crisis were NST nonreactivity and fetal movement scores. At these times, it is likely that the abnormal, sickled red blood cells block tiny capillaries, causing microthrombi (very small clots) to form. This, in turn, decreases the available oxygen supply and causes more sickling. However, it did not appear that the vascular changes during crisis affect the fetal circulation. The changes in fetal biophysiological functions associated with sickle cell crisis revert to normal, in most cases, when the crisis is past. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Physiological aspects, Sickle cell anemia, Pregnancy, Complications of, Pregnancy complications

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Twin gestation: fetal presentation as a function of gestational age

Article Abstract:

Fetal malpresentation may often spontaneously correct itself before the onset of labor in women who are pregnant with twins. Fetal malpresentation is an abnormal or anomalous position of the fetus in the uterus. Ultrasonography was used to examine fetal position in 119 women pregnant with twins every two weeks starting at 26 weeks of pregnancy. Thirty-seven percent of the twins were delivered by cesarean section. Fetal malpresentation was the most common reason for a cesarean section. Sixty percent of the twins spontaneously changed their position in the uterus between 28 and 30 weeks of gestation. Twenty-five percent to 30% changed their position spontaneously at term. Only 7% of the twins that were positioned head-to-head spontaneously changed their position in the uterus.

Management, Prevention, Cesarean section, Gestational age, Fetal presentation, Multiple birth

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